Department of Anaesthesiology and Intensive Care, Stavanger University Hospital, Stavanger, Norway.
Department of Paediatrics, Stavanger University Hospital, Stavanger, Norway.
BJOG. 2016 Jul;123(8):1370-7. doi: 10.1111/1471-0528.13778. Epub 2015 Dec 24.
The optimal timing of cord clamping (CC) in nonbreathing neonates needing stabilisation/resuscitation remains unclear. The objective was to describe the relationship between time to CC, initiation of breathing or positive pressure ventilation (PPV) after stimulation/suction and 24-hour neonatal mortality/morbidity.
Observational study.
A rural Tanzanian referral hospital.
Depressed nonbreathing newborns.
Trained research assistants have observed every delivery (November 2009 through January 2014) using stop-watches and recorded data including fetal heart rate; time intervals from birth to CC and start of breathing or PPV and perinatal characteristics.
Twenty-four-hour neonatal outcome (dead, admitted, normal).
There were 19 863 liveborn infants; 16 770 (84.4%) initiated spontaneous respirations, 3093 (15.6%) received stimulation/suctioning to initiate breathing. However, 1269 (41.0%) neonates failed to breath and received PPV at 98 ± 66 seconds and CC at 39 ± 35 seconds after birth. Adverse outcomes in neonates receiving PPV included 126 (9.9%) deaths and 100 (7.8%) neonatal admissions. In 1146/1269 (90%) neonates, CC occurred before PPV and was associated with 209 (18%) deaths/admissions. In 98 (8%) neonates, CC followed initiation of PPV with 14 (14%) deaths/admissions (P = 0.328). By logistic modelling, initiation of PPV before versus after CC was not associated with death/admission when adjusted for time to PPV. The risk for death/admission increased by 12% for every 30-second delay in PPV (P = 0.001).
This observational study failed to demonstrate any relationship between time to CC and onset of breathing or initiation of PPV following stimulation/suction, and 24-hour outcome. Delay in initiation of PPV was significantly associated with death/admission.
No relationship between time to cord clamp, breathing or ventilation and 24-hour deaths in depressed neonates.
对于需要复苏稳定的无呼吸新生儿，最佳的脐带夹闭（CC）时机仍不清楚。本研究旨在描述 CC 时间与刺激/吸引后开始呼吸或正压通气（PPV）以及 24 小时新生儿死亡率/发病率之间的关系。
观察性研究。
坦桑尼亚农村转诊医院。
无呼吸的新生儿。
经过培训的研究助理使用秒表观察每一次分娩（2009 年 11 月至 2014 年 1 月），记录数据包括胎儿心率；从出生到 CC 以及开始呼吸或 PPV 的时间间隔和围产期特征。
24 小时新生儿结局（死亡、住院、正常）。
共有 19863 例活产婴儿；16770 例（84.4%）自发呼吸，3093 例（15.6%）接受刺激/吸引以开始呼吸。然而，1269 例（41.0%）新生儿无法呼吸，在出生后 98±66 秒接受了 PPV，在 39±35 秒进行了 CC。接受 PPV 的新生儿不良结局包括 126 例（9.9%）死亡和 100 例（7.8%）新生儿住院。在 1269 例（90%）新生儿中，CC 发生在 PPV 之前，与 209 例（18%）死亡/住院相关。在 98 例（8%）新生儿中，CC 发生在开始 PPV 之后，与 14 例（14%）死亡/住院相关（P=0.328）。通过逻辑模型，当调整 PPV 时间时，CC 开始前与 CC 开始后进行 PPV 与死亡/住院无关。每延迟 30 秒开始 PPV，死亡/住院的风险增加 12%（P=0.001）。
本观察性研究未能证明 CC 时间与刺激/吸引后开始呼吸或开始 PPV 之间以及 24 小时结局之间存在任何关系。PPV 开始延迟与死亡/住院显著相关。
无呼吸新生儿的 CC 时间、呼吸或通气与 24 小时内死亡之间无关联。
